Healthcare Coverage

Most consumers have healthcare coverage from their employer. Others have medical care
paid through a government program such as Medicare, Medicaid, or the Veterans
Administration.

If you have lost your group coverage from an employer as the result of unemployment,
death, divorce, or loss of "dependent child" status, you may be able to continue
your coverage temporarily under the Consolidated Omnibus Budget Reconciliation Act
(COBRA). You, not the employer, pay for this coverage. When one of these events
occurs, you must be given at least 60 days to decide whether you wish to purchase
the coverage.

Some states offer an insurance pool to residents who are unable to obtain coverage
because of a health condition. To find out if a pool is available in your state,
check with your state department of insurance.

Most states also offer free or low-cost coverage for children who do not have health
insurance. Call 1-877-KIDS-NOW (543-7669) for more information.

Healthcare Plans

When purchasing health insurance, your choices will typically fall into one of three
categories:

Traditional fee-for-service health insurance plans are usually
the most expensive choice. But they offer you the most flexibility when choosing
healthcare providers.

Health Maintenance Organizations (HMOs) offer lower co-payments
and cover the costs of more preventative care, but your choice of healthcare providers
is limited. The National Committee for Quality Assurance evaluates and accredits HMOs.
You can find out whether one is accredited in your state by calling 1-888-275-7585.
You can also get this information as well as report cards on HMOs by visiting its
(website).

Preferred Provider Organizations (PPOs) offer lower co-payments
like HMOs but give you more flexibility when selecting a provider. A PPO gives
you a list of providers you can choose from.

WARNING: If you go outside the HMO or PPO network of providers, you may have to pay a
portion or all of the costs.

Appealing Health Insurance Claims

If your health insurer has denied coverage for medical care you received you have a right to appeal the claim and ask that the company reverse that decision. You can be your own health care advocate. Here’s what you can do:

Step 1: Review your policy and explanation of benefits.

Step 2: Contact your insurer and keep detailed records of your contacts (copies of letters, time and date of conversations).

Step 3: Request documentation from your doctor or employer to support your case.

Step 4: Write a formal complaint letter explaining what care was denied and why you are appealing through use of the company’s internal review process.